Association of timing of surgery for hip fracture and patient outcomes
Association of timing of surgery for hip fracture and patient outcomes
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DOI：
10.1001/jama.291.14.1738
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发表时间：
2004-04-14
影响因子：
120.7
通讯作者：
Siu, AL
中科院分区：
文献类型：
--
作者：
Orosz, GM;Magaziner, J;Siu, AL
上下文以往的研究在髋部骨折患者的手术时机已经产生了相互矛盾的结果死亡率，并没有集中在功能outcome.Objective检查髋关节骨折的功能和其他outcome. Design前瞻性队列研究，包括分析匹配的情况下，早期（：524小时）和晚期（>24小时）手术的倾向评分，并排除患者谁可能不会手术的时机。选择纽约市大都会区的四家医院。研究对象1206例年龄≥ 50岁的髋部骨折患者，截止1999年12月，住院时间超过29个月。主要指标功能（使用功能独立性测量）、生存率、疼痛和住院时间（LOS）。早期手术与死亡率改善（风险比，0.75; 95%置信区间[CI]，0.52-1.08）或运动改善（差异为-0.04分; 95% CI，-0.49至0.39）无关。早期手术与严重和非常严重疼痛的天数减少（差异为-0.22天; 95%CI，-0.41至-0.03）和LOS缩短1.94天相关（P
Context. Previous studies of surgical timing in patients with hip fracture have yielded conflicting findings on mortality and have not focused on functional outcomes.Objective To examine the association of timing of surgical repair of hip fracture with function and other outcomes,Design Prospective cohort study including analyses matching cases of early (:524 hours) and late (>24 hours) surgery with propensity scores and excluding patients who might not. be candidates for early surgery.Setting Four hospitals in the New York City metropolitan area. Participants A total of 1206 patients aged 50 years or older admitted with hip fracture over 29 months, ending December 1999.Main Outcome Measures Function (using the Functional Independence Measure), survival, pain, and length of stay (LOS).Results Of the patients treated with surgery (n=1178), 33.8% had surgery within 24 hours. Earlier surgery was not associated with improved mortality (hazard ratio, 0.75; 95% confidence interval [CI], 0.52-1.08) or improved locomotion (difference of -0.04 points; 95% Cl, -0.49 to 0.39). Earlier surgery was associated with fewer days of severe and very severe pain (difference of -0.22 days; 95% Cl, -0.41 to -0.03) and shorter LOS by 1.94 days (P